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1e a Te ch = SERVICE ORDER Environmental Inc. 196325 - 2581 S. Sunland Ave. . Fresno, CA 93725 - - Phone: 800-531-9683 WASTE RECYCLING RECEIPT Name: _ `� Customer Purchase Order# Address: _ 4 Sales Representative City, State, Zip: If C6 C 3 6 Phone #: EPA iD#: _[�-L G} ! �j Federa, Manifest#: QUANTITY UNITS U.S. DOT DESCRIPTION CHARGE GAL. USED OIL-NON RCRA HAZARDOUS WASTE,LIQUID CA WASTE CODE 221 GAL USED ANTI-FREEZE--NON RCRA HAZARDOUS WASTE, LIQUID CA WASTE CODE 134 cc OILY WATER FROM USED PARTS WASH SOLUTION- QCAL. NON-RCRA HAZARDOUS WASTE, LIQUID. CA WASTE CODE 134 cc LU DRUM(S) DRAINED USED OIL AND GAS FILTERS z ID TOTAL O w The above used oil is %Lubricating oft %.Industrial oil F- J ACCOUNT STATUS: { y C.O.D. { }OPEN ACCOUNT If open Account-payment is due net 30 days or a finance charge of 1.5% IL per month will apply. DGENERATOR'S NOTIFICATION AND CERTIFICATION:Any used oil That the transporter receives from the generator will be transported to a certified used oil recycling facility that is L.) lawfully operating In accardanee with a hazardous waste facilities permit issued pursuant to the Federal Act. I hereby declare that the canterits of this consignment are fully and W accurately described above by the proper DOT stripping name and are cNssilled,packaged,marked,and labeled and are In all aspects in proper coadrfion for Iranspon by 13,01,, m standards_All relevant Ipfarmation regarding known or suspected hazards associated with This waste has been disclosed.The customer agrees to pay reasonable cost and attorney 0 fens incurred in 166'colleclion of Ihis obligation.Venue for purposes at this obligation shall be In Los Angeles County.I certify that the v.wte minimization statement Identified In 40 CFR 26227(a)of I;*m a targe quantity generator)or(b)(if I am a small quantity generator)is true.I also acknowledge that I have read and agree to the farms an this farm both front and back.Signer§ltaraotees the payment of CleanTech invoices in accordance with the standard terms of Net 317 days.It a Purchase Order is not issued,the empreyae authorizing the work performed pliarantees that any invoices presented will be paid promptly.Prompt payment Is defined as payment in accordance with CleanTech standard terms of net 34 days. Invoice payment'is not contingent upon payment by a third party.Interest on past due accounts will be charged at the rate of 1.5%per month until paid In lull.WASTE MATERIALS WHICH ARE DISCOVERED TO OF NON-CONFORMING WILL BE SUBJECT TO AODITIONAL CHARGES. TYPE OR PA INT FULL NAME Sir'kATURE DATE I hereby certify that i have road and have the authority to bind the above listed generator io the terms found on both the front and back of this form.State Law requires that bath the Generator and Transporter keep(his form on file for a miaimum of(3)yeam f hereby cerlily that all information In this and all attached documents contain true and accurala descriptions of the waste including that the waste is segregated and is not cominliNd with other waste streams-As the Generator.I ackrloviledge that our sire EPA ID#is active.The waste stream listed above complies with the Waste Profile on record for Me designated Facllily.This document servos as written verification that tha wastestream(s)descrfpffen and constffuen!L found above are unchanged par the Facility Generator Waste Prorfle Warksheel and also acts as the annual written verification iorlhe Generator Waste Profile Worksheel of E.Ml B waste streams,I declare under penalty of perjury that the foregoing is true and correct Cc CleanTedh Environmental Inc. 2581 S. Sunland Ave. le Z- 0 Fresno, CA 93725 cCLn EPA I❑ #:CAL0�03B813+3 DRIVER'S NAME-TYPE OR RINT FU�NAM Z Truck, Unit ID No. 2- C/ - %GNAURE DATE The checked box is the designated recycling facility LU Z � ❑Roadrunner Glycol, Inc. ❑Southwest Processors ❑Heritage Environmental14 antech EnvIronm9rital J ,3 4635 Industrial Center Dr. 4120 Bandini Blvd. Services LLC 5820 Maltln Rd. > V Las Vegas, NV 89115 Vernon,CA 90058 284 East Storey Road Irwindale,CA 91708 CC w U. EPA#NVR000088427 EPA#CAL921646037 Coolidge,AZ 85128 EPA#CA L000330453 C. cc Ph#7021379-7179 Ph#80D1900-3366 EPA#AZD081705402 Ph#6261812-7200 Ph#5201723-4167